Having caused pain and misery for Welsh society throughout the ages, there is little positive to be found in the history of disease in Wales. But, look closely enough, and there are heroes among the gloom

THROUGHOUT history, epidemic diseases have preyed upon our ancestors, weeding out not only the elderly, weak and vulnerable but the healthy and vigorous.

Despite the relative success of modern medicine in treating many conditions which were previously fatal, the threat of epidemics and pandemics – most recently swine flu – continues to haunt us, stirring up popular fear and collective memories of past outbreaks. Even despite the passage of more than three centuries, for example, we can still relate to the fear of the famous diarist Samuel Pepys as he walked around the streets of plague-ridden London in 1666, noticing the many doors painted with red crosses, and “God Have Mercy” written ominously upon them.

But how have Wales and Welsh people fared in this story of sickness? Was Wales a hotbed of epidemic diseases? Actually, historians haven’t so far paid much attention to the subject, but the evidence is interesting.

Certainly Welsh people have suffered through the centuries, as we’ll see.

But occasionally, Wales, its landscape and geography, have also served to protect its people from the worst effects of plague and pestilence.

Plagues and poxes

The first recorded epidemic in Wales occurred in the sixth century. In 526AD, St Brioc of Brittany came to Ceredigion and wrote that the whole region was “overwhelmed by a great catastrophe”.

This was Y vad velen (the yellow plague), part of an epidemic outbreak noted across Britain.

Outbreaks of a plague-like disease recurred in 526AD and 537AD, but a further epidemic of Y vad velen in 547, caught the imagination of Welsh bards and poets for several hundred years to come.

The biographer of St Teilo vividly described it as coming over the land like the “column of a watery cloud”.

It was this “yellow pestilence” which “seized Maelgwyn, king of North Wales, and destroyed his country”.

According to legend, Maelgwyn sought sanctuary in the church of Llanrhos but was restless.

Unable to resist looking out upon his kingdom, he peeped through the keyhole of the church door, but even this tiny exposure to the outside air was enough for him to catch the infection. Curiosity, in this case, killed the king.

Throughout the Middle Ages and medieval period, a succession of plagues and sicknesses continued to haunt Wales, but references are scant.

Various medieval Welsh annals and chronicles refer fleetingly to extreme events such as epidemics or natural phenomena which occurred from time to time.

In 896, it was even recorded that a plague of vermin “like moles” fell from the skies and devoured everything they encountered.

But the fear of sickness was certainly deeply entrenched in Welsh culture as it was elsewhere, and it was common for diaries and letters to contain references to troubling “new” diseases. In 1657, the Flintshire puritan Philip Henry made reference to reports of “fourscore children sickened of a new disease” in “Swansey in Glamorganshire”. In 1734, the Welsh MP John Campbell wrote from London to his young son, Prys, worrying about an outbreak of “violent coughs” affecting children “all about the countrey (sic)”.

Some diseases, however, were so abhorrent that they even entered popular culture. Few achieved the same levels of infamy as did Y Frech Wen – the smallpox.

Smallpox was a virulent disease which became epidemic in 17th and 18th century Britain, and accounted for around 15% of total deaths in the period.

Wales certainly did not escape. In 1722/23, 71 people died of the disease in Carmarthen, and further severe outbreaks followed over the next few years.

What made smallpox seem all the more vicious was that it was most often a disease of childhood. Surviving it was almost a rite of passage for children, but there was a sting in the tail since recovery, though it gave immunity from further infection, often left the sufferer horribly scarred.

Smallpox also came with a certain degree of social stigma, leaving scarred survivors ostracised from their friends and families.

It could run rampant through families and communities and, in the days before inoculation, there was little defence. So feared was it that advertisements for servants in 18th century households sometimes stipulated that applicants must already have had the disease, to prevent them bringing the infection into a family.

The disfiguring nature of smallpox found its way into literature and poetry.

The medieval Welsh poet Tudur Aled wrote of the visible effects of smallpox, describing warrior’s shields as being dented and pitted as though with smallpox.

Another, Cadwaladr Roberts of Pennant Melangell bemoaned the ravages of the “pox of pain” upon his own face in the 1730s.

No longer attractive to a “beautiful and unstained girl”, Cadwaladr believed that only a “keen witch” would now wed him, “this grubby elf with perforated skin”.

But even apparently innocent verse, such as children’s nursery rhymes, sometimes carried more sinister undertones.

The Welsh nursery rhyme “cân nant y eira”, tells of a small boy who wears his beaver-skin hat low upon his brow to hide his smallpox scars and dimples.

Something of this disease still echoes in modern times.

In 1962, smallpox hit the town of Maerdy in the Rhondda.

Sufferers were warned by doctors that they could expect different treatment by friends and neighbours; the stigma of smallpox scars, it seems, was not consigned to the past.

Epidemics of gastro-enteric diseases, such as dysentery, were also common in the 17th and 18th centuries.

Dysentery, known by contemporaries as The Bloody Flux, was a disease spread by infected food and water, and also by flies.

This was a summer disease, more virulent in warm and humid weather, and was especially common in coastal towns and especially ports, introduced by visiting ships whose crew carried the infection.

It was common in reports of epidemics for writers to include shocking vignettes of the aftermath, such as grass growing over the streets and not enough people being left to bury the dead. Just such a report was included in a letter relating an outbreak of the disease in Cardiff in 1697.

Perhaps most synonymous of all epidemic diseases is that of bubonic plague. How badly affected was Wales by this most dreaded infection?

Bubonic plague was present in England from the Middle Ages until the middle of the 17th century although it tended to be a visitor rather than a permanent resident.

It moved rapidly through densely populated areas which meant that it was more often a disease of the towns, although rural parishes were certainly affected.

Affected by weather patterns, it tended to peak in the late summer months and affected adolescents and adults, more than children, and both sexes alike.

Wales certainly suffered a number of outbreaks, and larger towns, and port towns in particular, were badly hit.

Carmarthen suffered five major outbreaks, in 1604, 1606, 1611, 1651 and 1657.

Presteigne suffered four outbreaks of plague, its authorities threatening to restrict people’s movements in 1636 to prevent them spreading the disease.

That same year, one unscrupulous man from a neighbouring parish was actually bound over by magistrates for threatening to go to Presteigne to deliberately contract the plague so that he could infect his estranged wife.

Other towns, such as Wrexham and Haverfordwest were also particularly badly hit while, at the peak of an outbreak in Chester in 1603, over 150 people were dying every week.

An outbreak of plague in Tenby in 1650 is supposed to have killed 500 people when the town had a population of less than 1,000.

This occurred at a time of economic hardship in the town, through declining trade and fishing revenues. It was reported that the town’s mayor had to employ people to retrieve food from outside the boundaries, as nobody would dare to enter the pestiferous town.

Neither was it only towns that were hit. An isolated outbreak of plague that hit Bedwellty parish in Monmouthshire killed 82 people in 1638, the parish registers revealing a solemn tale of mortality. The diarist Walter Powell in fact wrote that the disease was “very hot in diverse parts of Monmouthshire”.

Next page: But how did Wales fare in comparison to the rest of Britain?

But how did Wales fare in comparison to the rest of Britain?

Actually, although the rates of plague mortality here are chilling, it does seem that Wales suffered less than other parts of Britain. Why could this have been?

One explanation is that of the actual landscape of Wales itself.

Bubonic plague was less virulent at higher altitudes, and colder environments both of which abound in Wales.

There were fewer large towns in Wales than in other areas, while many parts of the Welsh countryside were relatively sparsely populated, making it more difficult for the disease to establish itself.

The exception to this was Wales’ coastline. With well over a hundred miles of coast, and numerous large and small ports, there was ample opportunity for the introduction of disease and it is probably no coincidence that port towns, and also towns along rivers and trading routes, were the worst hit.

Disease in industrial Wales

Living conditions certainly did not do anything to check the spread of disease.

In pre-industrial Wales, housing and diet were both proverbially poor.

Welsh rural cottages, uncharitably referred to by one English observer as resembling “great blots of cow turd” on the landscape, were often basic at best, and squalid at worst.

Close proximity to animals meant contact with dung and flies, and clay floors covered with straw trapped filth and soaked up urine.

Since people did not routinely wash themselves, infestations of lice and skin conditions were common. Things were little better in Welsh towns, the poor dwelling in small alleys and courtyards away from their more affluent neighbours.

The practice of emptying human waste onto the street left many public spaces as little more than open sewers. Even as late as 1740, the authorities in Aberystwyth chastised townspeople for “lay(ing) downe their dunghill opposite their doors”.

Visitors to towns from rural areas risked infection through encountering diseases for which they had no immunity. From two or three centuries distance, it is perhaps difficult for us now to imagine that such conditions existed on our own doorsteps.

As Wales began to industrialise, patterns of mortality also began to change. In the 19th century, ever-growing numbers of migrant workers poured into newly created industrial towns from both within and outside Wales.

The need to accommodate workers quickly necessitated the rapid building of large numbers of houses, often quickly erected and with few rooms and little living space.

It was not unusual for several families to occupy one house, and the proximity of large numbers of people, and in sometimes squalid conditions, allowing diseases to spread with alarming speed.

Even the industrial environment itself brought new dangers.

The new powerhouses of production, such as the iron works at Penydarren and Dowlais pumped sulphurous chemicals into the air, while the thick coal dust of the pits clogged up the lungs of generations of Welsh miners.

One of the worst offenders was the newly developing Swansea copper industry. The smoke from copper manufacture was brimming with dangerous and harmful by-products, including sulphuric acid and even arsenic.

Daily exposure to this toxic fug could exacerbate a range of bronchial conditions, and also lower immunity, serving to increase incidences of other diseases such as consumption and fever.

Coppermasters fought back, however, and argued that not only was copper smoke harmless, it was actually healthy.

A report to the Board of Health by the Swansea doctor Thomas Williams in 1854, asserted the presence of copper smoke was in fact extremely beneficial since its antiseptic properties acted as a protective cordon to keep disease at bay.

Cholera and typhus were indicative of the sorts of epidemic diseases to torment industrial Welsh towns.

Cholera, caused through contaminated drinking water, caused vomiting, diarrhoea and cramps which, in severe cases, could cause death within a matter of hours.

Typhus and typhoid claimed many lives across Wales between the 1830s and 1860s, and often hit the poor hardest, not least as they often swept through institutions such as workhouses with alarming speed and ferocity.

In the mid-19th century, Merthyr parish included prospering towns such as Aberdare, then an iron-producing town of around 45,000 inhabitants. In 1849, the parish was visited by an outbreak of cholera killing more than 1,500 people.

In the 1854 Public Health Act inquiry into the outbreak, a local doctor, David Davies, reported on the lack of drainage and clean water serving Aberdare, noting that inhabitants still emptied their waste out of upstairs windows onto the open street.

Davies was a key figure in the provision of clean water for the town through the construction of a new reservoir, and also established a fever hospital there in 1871, one of many such institutions beginning to appear around Wales during this period.

But if the 19th century is often viewed as the harbinger of “modern” or “scientific” medicine, it is certainly not true that new developments were always welcomed with open arms.

Vaccination was a hot topic in 19th century Wales. The introduction of inoculations for smallpox, cowpox and measles was adopted swiftly in many areas, and in fact was embedded in law in 1853, making it mandatory to inoculate infants.

Measles was another major killer in industrial Wales.

In Blaenavon in 1870, a measles outbreak increased the mortality rate from 22 to 166 per 1,000 births and, at its height, six or seven children were dying there every day.

But there was also something of a backlash.

In Newport, some parents argued against the safety of the vaccinations, and were in fact prosecuted for refusing to present their children according to the requirements of the Vaccination Acts.

On July 31, 1869, the Western Mail reported on a conference about vaccination held in Cardiff, at which a certain Dr Haviland reported his disgust at seeing children forcefully injected even in the waiting rooms of railway stations by over-zealous overseers. The case for the success of vaccination, he argued, was unproven.

Secretary of State for Health, Aneurin Bevan

Villains... and heroes?

We could simply stop there and conclude that the people of Wales, throughout history, have been bedevilled by all manner of epidemic and endemic diseases attacking minds and bodies and leaving chilling traces in the records of our ancestors.

But, in the midst of all this villainy, it is perhaps nicer to reflect on one particular hero to whom Wales can legitimately lay claim.

On July 5, 1948, after much brokering, negotiation and even a dramatic stand-off with the British Medical Association, the then Secretary of State for Health launched the new National Health Service in a weary, post-war Britain.

For the first time, health care was available to the whole of the UK population free of charge, effectively ending a tiered system of medical provision, and opening up a range of treatment options to those previously unable to afford it, or reliant on charity.

Despite contemporary criticisms of the NHS, it still provides millions of people in Wales and beyond with a level of healthcare which, only a mere few of generations ago, would have seemed utopian. And who was this social-minded minister? Aneurin Bevan of Tredegar.